Cross-sectional and longitudinal analysis of the COPD assessment test in a Canadian population of men and women with early and moderate-severe COPD
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Résumé
Background and objectives: The recently updated Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy recommends a new multidimensional approach for chronic obstructive pulmonary disease (COPD) assessment and management that now includes patient perceived disease impact. It proposes using the COPD Assessment Test (CAT) to measure the impact of COPD on wellbeing. This self-administered questionnaire provides a simple quantified measure of health-related quality of life (HRQoL). Summarising the current knowledge on the performance of this tool as a HRQoL measurement instrument is warranted, especially as the test could have important roles in COPD clinical practise and research.We aimed to systematically search the literature to evaluate the psychometric properties of the CAT (reliability, validity, responsiveness and minimum clinically important difference (MCID)) as a HRQoL instrument used in patients with COPD, and evaluate the validity of the CAT in specific patient population characteristics and measure the annual change in CAT score over 3 years.Methods: A systematic review was performed to assess the psychometric properties of the CAT in adults with COPD and to identify gaps within the literature concerning the questionnaire. The CAT was administered at baseline, 1.5 and 3 years to subjects with COPD in a population-based, prospective multicentre cohort study conducted throughout Canada. The CAT total score was determined for different levels of COPD disease stage, sex, age and smoking status. Mixed-effects linear models were used to estimate the relationship between the change in CAT score over the range of observed study years.Results: The systematic review identified 36 studies that evaluated CAT psychometric properties. Internal consistency (reliability) was 0.85â0.98 and test-retest reliability was 0.80â0.96. CAT total scores differed with GOLD stages and exacerbation. Mean scores decreased with pulmonary rehabilitation (2.2â3 units) and increased at exacerbation onset (4.7 units). Only one study with adequate methodology reported an MCID of 2 units and 3.3â3.8 units using the anchor-based approach and distribution-based approach, respectively. None of the studies conducted a longitudinal evaluation past 6 months.For the study in Canada, 643 subjects with COPD were included in the analysis. The mean CAT total score was 7.8 ± 6.6, 5.7 ± 5.0, 9.6 ± 6.7 and 14.9 ± 9.3 for all subjects, GOLD I, II and III+, respectively. Females scored higher than males in all GOLD grades, though it was only statistically significant in GOLD I and II. The interaction effect between year and GOLD stage demonstrated that the annual change in CAT score over 3 years differed among the three GOLD groups, particularly in GOLD III+ compared with GOLD I (Ã=-1.08, 95% CI (-2.02, -0.16)). The CAT score did not show any significant change over the study period of 3 years in each GOLD grade.Conclusions: Studies support the CAT's reliability, validity and responsiveness, however the MCID remains debatable. The characterisation of CAT scores in particular patient populations established that females scored higher than males in all GOLD grades. Three-year longitudinal follow-up could not show any significant change in CAT score among GOLD grades.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle